Soft tissue therapy for Multiple Sclerosis (MS)

By Guido4 (Own work http://www.hegasy.de/) [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons

Multiple Scelrosis (MS) is a condition of the nervous system that can have detrimental effects on various systems and functions of the body. Soft tissue therapy and other lifestyle changes can help in the management and reversal of the condition. 

Background
 
Multiple sclerosis, MS for short, affects the nerves in the brain and spinal cord. It causes problems with movement, vision, and balance. Essentially it is a disease of the Central Nervous System (CNS).
 
Nerves in the brain and the spinal cord are surrounded by a layer, called a myelin sheath. It is made up of lipids and proteins. Its function is to protect the nerve and help it transmit electrical signals between the brain and the rest of the body. Progressive damage and degeneration of this myelin sheath is termed MS.
 
There is a sequence of events the body attacks its own myelin sheath mistaking it for a foreign threat. This autoimmune reaction leads to inflammation and breaks down of the myelin sheath. This is then followed by the body’s attempts to repair the damage, which creates scarring, also known as sclerosis. Over time the amount of scarring in the CNS increases.
 
So, it becomes clearer how the name is derived. Multiple indicates that more than one area of the brain and spinal cord can be affected and sclerosis stands for the nerve tissue scarring that occurs. This makes it more difficult for nerve impulses from the brain to reach their target body parts and fulfil their functions effectively.
 
Signs and Symptoms
 
Common symptoms of MS include numbness in various parts of the body and fatigue. Which nerve pathways are damaged will determine where in the body these symptoms are.
 
Other symptoms include problems with walking, balance and coordination. Problems with vision, dizziness, and vertigo may also be present.
 
MS can adversely affect the function of the bladder and/or bowels and lead to sexual dysfunction. Deterioration in cognition and speech are also possible.
 
Some people experience emotional changes, which can lead to depression. Spasticity, particularly in the legs, tremors and weakness are also among the common symptoms.
 
Causes and pathology
 
The medical field has not reached a conclusion about what causes MS. There are some theories suggesting a possible explanation. In general, it is not considered a genetic disease, although a predisposition can be inherited.
 
It seems that location is an important factor as there is practically no MS near the equator. Research tries to find out whether this can be attributed to bacterial issues. Alternatively, it may be caused by insufficient sun exposure, which interferes with the natural production and function of vitamin D in the body.
 
An alternative view suggests that MS may be linked to blood flow restriction caused by narrowing of veins inside the brain and the spinal cord. According to this theory, the brain and spine blood supply have trouble returning to the heart. This leads to tiny iron deposits inside the nerves, which can damage them and cause an autoimmune reaction.
 
In the medical field, MS is divided into 4 categories:

• Relapsing-remitting MS (RRMS) is the most common form. 85% of the initial diagnoses fall in this category. Flare-ups followed by periods of remission where all symptoms may disappear are common for this type.
• In secondary progressive MS (SPMS) the condition deteriorates over time with or without periods of remission.
• Primary progressive MS (PPMS) accounts for about 10% of the initial diagnoses. In this category, there is a continual and progressive degeneration of symptoms from the start without remission.
• Progressive relapsing MS (PRMS) accounts for the remaining 5% of cases. Here the condition progressively deteriorates from the start but there are also flare-ups and periods of remission.

 
Research as to the causes and treatments is still ongoing but there is no definitive cure for the moment.
 
How soft tissue therapy can be used to treat this condition
 
Massage and other forms of soft tissue therapy can be important and beneficial for managing MS symptoms and improving patients’ life quality. There are few clinically controlled studies and lots of practical experience demonstrating the positive overall effect of massage. A 45-minute massage session twice weekly for five weeks led to lower anxiety and less depressed moods against the control group in a clinical study. By the end of this trial, the massage group showed improved self-esteem, better body image, and enhanced social functioning.
 
There is a lot of anecdotal evidence suggesting that soft tissue therapy can relieve symptoms such as muscle spasms and tremors. Pain reduction and improved sleep are also reported often.
 
In order to ensure that the therapist ‘does no harm’ it is important to consider the following contraindications:

• Heat and vibration are to be avoided as they may cause the nerves to fire.
• Vertigo may also be a problem when the client gets on and off the couch.
• Self-injection areas, if part of the client treatment plan, are to be avoided.
• Assisted stretches are not advisable as this may trigger sympathetic nervous system response and cause muscle spasms. Self-stretching and Yoga, on the other hand, have been very beneficial for many people with MS.
• Bone density may be lower in people with MS. This may lead to osteoporosis so extra care needs to be taken when manipulating bones and joints.

 
Massage and soft tissue therapy can reduce excessive muscle tone, increase local circulation and improve ROM, which can help with spasticity. The elongation and decompression of muscles may be hugely beneficial for people with MS.
 
Better nutrition, oxygenation, and waste removal can also be accomplished for MS clients receiving massage. This will not only ease the muscle but is likely to reduce the autoimmune response and also clear the nerve pathways from muscle compressions.
 
Overall then, this can lead to greater mobility and less stiffness for the client. Balance and coordination may also be enhanced as a result of improved muscle function.
 
By reducing spasticity and pain for the client, their sleep quality may improve which can reduce fatigue and tiredness. Given that the muscles move more freely, there is less energy expenditure in daily life. This energy preservation is also likely to reduce fatigue.
 
The emotional benefits of soft tissue therapy start with relaxation, proceed toward the release of feel-good hormones triggered by the human touch, and go on to deliver a healthier self-image and happier mood.
 
A sample treatment
 
Each client and each therapist are unique, so what is most beneficial is likely to emerge and be modified as their professional relationship evolves. In general, it is important to ensure that the client feels secure on the table and comfortable with skin to skin contact. This itself will already contribute towards a deeper relaxation.
 
Full-body treatments tend to work very well. Hands and feet affected by spasticity may be a good starting point. As the therapist moves to larger muscle groups, light to medium pressure would be most appropriate.
 
Tremors may occur at any time in people with MS. If this happens during a treatment, it may be most appropriate to gently place one’s arm over the affected area to facilitate relaxation rather than completely withdraw contact. If the tremors are very bad and the client starts feeling very anxious, the therapist can guide them towards a deep breathing practice to activate the parasympathetic nervous system and promote relaxation.
 
In leg work, long gentle strokes are appropriate while avoiding the area of the knees and behind them. If there is fluid retention, lymphatic drainage movements may be very appropriate. Although one side may seem to be more affected it is important to work on both sides to ensure potential imbalances are addressed. It is also recommended to avoid the groin area as it may be more sensitive or associated with feelings of anxiety.
 
When adjusting the client’s position, it is best to ask them to actively move their limbs instead of doing it for them in order to avoid spasmodic reactions.
 
Particularly tight or ‘knotty’ areas, can be treated with neuromuscular techniques. 
 
Head and neck work would also be very soothing and beneficial. 10-15 minutes of head and scalp work at the end of the treatment may be very relaxing for the client.
 
At the end, it is important to ensure that the client gets up slowly and carefully at their own pace. If the therapist has to assist the client, it is important to towel manage them accordingly.
 
Weekly to twice weekly schedule is usually best for delivering lasting and noticeable results.
 
Lifestyle advice and support
 
Research and practice show that lifestyle factors play a significant role in managing MS symptoms and improving quality of life.

• Eating more nutritious foods can be very beneficial. Neurologists tend to recommend a diet with plenty of raw fruit and vegetables along with omega-3 fatty acids for people with MS.
• Regular movement is absolutely essential. Regular exercise promotes flexibility, can improve balance and help with bowel movements and sleep quality. Yoga, Tai-Chi, bodyweight exercises and walking are all excellent choices.
• Brain exercises are important to help people with MS retain and improve their cognitive functioning. Crossword puzzles, sudoku, chess, brain training apps are all an excellent choice. Social stimulation and interaction are also advantageous.
• Sleep is critical for people with MS. It can be improved by receiving regular massage, keeping the room completely dark and at an appropriate temperature and avoiding mental stimulation late in the day.
• Sunshine and sufficient vitamin D are important as their absence may be a contributing factor for MS.
• Mindfulness, meditation and psychotherapy can also be hugely beneficial in terms of emotional health, stress reduction and preventing depression.
• Eliminating alcohol, tobacco, caffeine, and other drugs or stimulants is also important for maintaining overall health. Smoking, in particular, is a big risk factor.
• Adequate body temperature is important as overheating can aggravate the nerves and cause them to fire haphazardly.